U.S. patent number 10,470,785 [Application Number 15/403,084] was granted by the patent office on 2019-11-12 for surgical apparatus including articulation gear.
This patent grant is currently assigned to Aesculap AG. The grantee listed for this patent is AESCULAP AG. Invention is credited to Radulf B. R. Bosuego, Bryan D. Knodel, Jinhoon Park.
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United States Patent |
10,470,785 |
Knodel , et al. |
November 12, 2019 |
Surgical apparatus including articulation gear
Abstract
One example of a surgical apparatus may include an end effector;
a shaft extending proximally from the end effector, the shaft
including an articulation region; a handle including at least one
button; an articulation gear held by the handle, where at least one
cam path is defined in the articulation gear; and at least one
holder post extending into each cam path; where actuation of one
button causes the end effector to articulate through a discrete
angular increment relative to the shaft.
Inventors: |
Knodel; Bryan D. (Flagstaff,
AZ), Park; Jinhoon (Palo Alto, CA), Bosuego; Radulf B.
R. (Newark, CA) |
Applicant: |
Name |
City |
State |
Country |
Type |
AESCULAP AG |
Tuttlingen |
N/A |
DE |
|
|
Assignee: |
Aesculap AG
(DE)
|
Family
ID: |
49300954 |
Appl.
No.: |
15/403,084 |
Filed: |
January 10, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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13439639 |
Apr 4, 2012 |
9566048 |
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13094716 |
Oct 25, 2016 |
9474527 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
17/072 (20130101); A61B 17/2909 (20130101); A61B
17/00 (20130101); A61B 17/07207 (20130101); A61B
2017/07271 (20130101); A61B 2017/00327 (20130101); A61B
2017/2927 (20130101); A61B 2017/00407 (20130101); A61B
2017/07278 (20130101); A61B 2017/00473 (20130101); A61B
2017/2923 (20130101) |
Current International
Class: |
A61B
17/064 (20060101); A61B 17/072 (20060101); A61B
17/29 (20060101); A61B 17/00 (20060101) |
Field of
Search: |
;227/175.1-182.1 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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Sep 2002 |
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EP |
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2258281 |
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Dec 2010 |
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EP |
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2005160933 |
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Jun 2005 |
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JP |
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2080833 |
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Jun 1997 |
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RU |
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8101953 |
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Jul 1981 |
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WO |
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8501427 |
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Apr 1985 |
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WO |
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2004103430 |
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Dec 2004 |
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WO |
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Other References
Cardica Microcutter Implant Delivery Device 510(k), Cover Sheet,
Table 10.1, "Substantial Equivalence Comparison", and Section 12,
"Substantial Equivalence Discussion", 2010--6 pages. cited by
applicant .
Gong, S., "Perfectly Flexible Mechanism and Integrated Mechanism
System Design", Mechanism and Machine Theory 39(2004), (Nov.
2004)--pp. 1155-1174. cited by applicant .
International Search Report and Written Opinion for International
Application No. PCT/US2013/034322, dated Jul. 12, 2013--9 pages.
cited by applicant .
Lim et al., "Application of Type Synthesis Theory to the Redesign
of a Complex Surgical Instrument", Journal of Biomechanical
Engineering (124), (Jun. 2004)--pp. 265-274. cited by applicant
.
Lim et al., "A Review of Mechanism Used in Laparoscopic Surgical
Instruments", Mechanism and Machine Theory 38, (2003)--pp.
1133-1147. cited by applicant .
Lim, J., "Type Synthesis of a Complex Surgical Device", Master
Thesis, (Feb. 21, 2001)--45 pages. cited by applicant .
Kolios et al., "Microlaparascopy", J. Endourology 18(9), (Nov.
2004)--pp. 811-817. cited by applicant .
Steichen et al., "Mechanical Sutures in Surgery", Brit. J. Surg.
60(3), (Mar. 1973)--pp. 191-197. cited by applicant.
|
Primary Examiner: Tecco; Andrew M
Assistant Examiner: Jallow; Eyamindae C
Attorney, Agent or Firm: RatnerPrestia
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATION(S)
This application is a divisional of U.S. application Ser. No.
13/439,639, filed on Apr. 4, 2012 and a continuation-in-part of
U.S. Pat. No. 9,474,527, filed on Apr. 26, 2011. The contents of
the aforementioned U.S. provisional patent application and U.S.
patent applications are hereby incorporated by reference in their
respective entireties for all purposes.
Claims
What is claimed is:
1. A surgical apparatus comprising: an articulation gear; a
plurality of distinct cam paths each defined as a recess in said
articulation gear; at least one holder post extending into each cam
path; and a handle including at least one button, wherein at least
part of said articulation gear is held within said handle, wherein
said at least one button includes a holder post deflection cam
defined thereon, wherein each holder post and corresponding cam
path are movable relative to one another, each holder post
remaining within said corresponding cam path during such relative
motion, and wherein distal motion of said at least one button
causes said holder post deflection cam on said at least one button
to move linearly in the distal direction to engage at least one of
the holder posts.
2. The surgical apparatus of claim 1, wherein each holder post is
biased outwardly by a bias into contact with a surface of its
corresponding cam path, and wherein said holder post deflection cam
moves a corresponding holder post against said bias.
3. The surgical apparatus of claim 1, further comprising a pusher
arm extending from said at least one button, wherein said
articulation gear includes a plurality of outer teeth defined along
at least part of a perimeter thereof, wherein distal motion of said
at least one button causes said pusher arm to engage at least one
of the outer teeth and thereby rotate said articulation gear.
4. The surgical apparatus of claim 1, wherein distal motion of said
at least one button additionally causes rotation of said
articulation gear; wherein an outer surface of at least one said
cam path includes at least one ramp adjacent to at least one notch;
and wherein rotation of said articulation gear causes at least one
holder post to slide along said at least one ramp and then into
engagement with said at least one notch.
5. The surgical apparatus of claim 1, wherein at least one cam path
includes a lower surface.
6. The surgical apparatus of claim 1, further comprising a toothed
spindle extending from said articulation gear.
7. The surgical apparatus of claim 6, further comprising at least
one articulation band that engages said toothed spindle.
8. The surgical apparatus of claim 7, wherein two articulation
bands engage said toothed spindle; and wherein rotation of said
toothed spindle causes differential motion of said articulation
bands.
9. The surgical apparatus of claim 8, wherein said differential
motion consists of proximal motion of one of said two articulation
bands and distal motion of another of the two articulation
bands.
10. The surgical apparatus of claim 1, wherein distal motion of
said at least one button causes said articulation gear to rotate
through a discrete increment of rotation.
11. The surgical apparatus of claim 10, wherein said articulation
gear stops rotation and maintains its rotational position upon
cessation of distal motion of said at least one button.
12. The surgical apparatus of claim 1, wherein said handle
comprises two buttons, wherein one of the two buttons is associated
with clockwise rotation of said articulation gear, and wherein
another of the two buttons is associated with counterclockwise
rotation of said articulation gear.
13. The surgical apparatus of claim 1, wherein said recess is
defined completely through said articulation gear.
14. A surgical apparatus comprising: an articulation gear; a
plurality of distinct cam paths defined in said articulation gear;
at least one holder post extending into each cam path; a torsion
spring engaged with said articulation gear, wherein said torsion
spring having a bias that biases said articulation gear to a
neutral position; and a handle including at least one button,
wherein at least part of said articulation gear is held within said
handle, and wherein said at least one button includes a holder post
deflection cam defined thereon.
15. The surgical apparatus of claim 14, further comprising an
anchor extending from said articulation gear radially outwardly
from an axis of rotation of said articulation gear, wherein a
portion of said torsion spring wraps around said anchor.
16. The surgical apparatus of claim 14, further comprising at least
one upper tooth on an upper surface of said articulation gear.
17. The surgical apparatus of claim 16, wherein said at least one
button comprises a holding arm, and wherein engagement between said
holding arm and said at least one upper tooth holds said
articulation gear in position against said bias of said torsion
spring.
Description
FIELD OF THE INVENTION
The invention generally relates to surgical instruments, and more
specifically to the articulation of surgical instruments.
BACKGROUND
Minimally invasive surgery is performed through small incisions in
the body, into which trocar ports may or may not be placed. One or
more surgical instruments are inserted through each incision in
order to perform the surgical procedure. In order to effectuate one
of the objectives of minimally invasive surgery, which is the
minimization of incisions to the body to reduce healing time and
scarring, it is desirable to minimize the number of incisions made
in the body. The number of incisions and their placement are
determined by the particular surgical procedure to be performed and
the configuration of the instruments used to carry out that
procedure.
One problem encountering during the performance of a minimally
invasive surgical procedure is access to the tissue to be treated.
Depending on the specific anatomy of the patient, it may be
difficult to reach an area to be treated with a specific surgical
instrument. As a result, one or more additional incisions may need
to be made in the patient in order to access that tissue. The
surgeon may need to obtain a different surgical instrument, adding
to the time and expense of the procedure. Additionally, where more
incisions may be made or additional instruments may be utilized, it
can be difficult and/or time-consuming for the surgeon to find the
surgical site again.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic view of a surgical tool.
FIG. 2 is a perspective view of an exemplary surgical tool.
FIG. 3 is a perspective view of the end effector of the exemplary
surgical tool of FIG. 2.
FIG. 4 is a perspective cutaway view of an articulation assembly
located in the handle of the exemplary surgical tool of FIG. 2, in
a neutral configuration.
FIG. 5 is a perspective view of an articulation button of the
articulation assembly of FIG. 4.
FIG. 6 is an end view of the articulation button of FIG. 5.
FIG. 7 is a perspective view of an articulation gear of the
articulation assembly of FIG. 4.
FIG. 8 is a side view of the articulation gear of FIG. 7.
FIG. 9 is a perspective cutaway view of the articulation assembly
of FIG. 4.
FIG. 10 is a perspective cutaway view of the articulation assembly
of FIG. 4.
FIG. 11 is a perspective cutaway view of the articulation buttons
and articulation gear during articulation through a first discrete
angle.
FIG. 12 is a perspective cutaway view of the articulation buttons
and articulation gear at completion of articulation through a first
discrete angle
FIG. 13 is a perspective cutaway view of the articulation assembly
at the limit of articulation.
FIG. 14 is a perspective view of a feeder belt to which staples are
frangibly connected.
FIG. 15 is a top view of another embodiment of an articulation
gear, including at least one cam path defined therein.
FIG. 16 is a perspective view of the articulation gear of FIG. 15,
with a holder frame inserted into two cam paths.
FIG. 17 is an upper cutaway view of an exemplary handle of a
surgical tool, with the articulation gear of FIG. 15 held within
the handle in a neutral position.
FIG. 18 is a perspective view of another exemplary articulation
button.
FIG. 19 is an upper cutaway view of an exemplary handle of a
surgical tool, with the articulation gear of FIG. 15 held within
the handle, and the left articulation button depressed.
FIG. 20 is a perspective view of the articulation button of FIG.
18, engaging a holder post.
FIG. 21 is a top view of the articulation gear and holder frame of
FIG. 16 in a second discrete position.
FIG. 22 is a top view of the articulation gear and holder frame of
FIG. 16 in a third discrete position.
FIG. 23 is a top view of the articulation gear and holder frame of
FIG. 16 in a fourth discrete position.
FIG. 24 is an upper cutaway view of an exemplary handle of a
surgical tool, with the articulation gear of FIG. 15 held within
the handle, and the right articulation button depressed to begin
articulation return.
The use of the same reference symbols in different figures
indicates similar or identical items.
DETAILED DESCRIPTION
U.S. Patent Application Publication No. 2009/0065552, published on
Mar. 12, 2009 (the "Endocutter Document"), is hereby incorporated
by reference herein in its entirety.
Referring to FIGS. 1-2, an exemplary end effector 4 of a surgical
tool 2 may include a staple holder 8 and an anvil 6, where at least
one of the staple holder 8 and the anvil 6 are rotatable and/or
otherwise movable relative to one another. The staple holder 8 and
anvil 6 need not be directly connected together in order to move
relative to one another, as set forth in greater detail below.
However, the staple holder 8 and the anvil 6 may be directly
connected to one another in any suitable manner, if desired. The
staple holder 8 and anvil 6 may be configured substantially as set
forth in the Endocutter Document, as modified by the contents of
this document. The staple holder 8 and anvil 6 may be fabricated
from any suitable material or materials. As one example, both the
staple holder 8 and anvil 6 may be fabricated from stainless steel.
As another example, at least one of the staple holder 8 and anvil 6
may be fabricated at least in part from a ceramic material, to
provide enhanced stiffness. As another example, the end effector 4
may be any other suitable item for treating or visualizing tissue,
such as but not limited to at least one electrode (bipolar or
otherwise), adhesive applicator, camera, ultrasound emitter,
forceps, or other items. The end effector 4 may be connected to the
distal end of a shaft 10. The shaft 10 may be rigid along part or
all of its length, and/or may include an articulating region 12,
such as described in U.S. patent application Ser. No. 12/400,760,
filed on Mar. 9, 2009 (the "Articulation Document"), which is
hereby incorporated by reference in its entirety. As another
example, the shaft 10 may be proximally spaced apart from the end
effector 4, such that the articulating region 14 is connected to
the end effector 4 and thereby spaces the shaft 10 apart from the
end effector 4.
The handle 12 may be attached to the proximal end of the shaft 10,
or any other suitable portion of the shaft 10. The shaft 10 may be
fabricated integrally with the handle 12. Alternately, the shaft 10
and the handle 12 may be two separate items that are connected
together in any suitable manner. The handle 12 may include any
mechanism, mechanisms, structure or structures that are suitably
configured to actuate the end effector 4. The handle 12 may be
actuated purely by hand, meaning that the handle 12 mechanically
converts force applied thereto by hand to force utilized to actuate
the end effector 4. As another example, the handle 12 may include a
source of stored energy for actuating the end effector 4. The
source of stored energy may be mechanical (such as a spring),
electrical (such as a battery), pneumatic (such as a cylinder of
pressurized gas) or any other suitable source of stored energy. The
source of stored energy, its regulation, and its use in actuating
the end effector 4 may be as described in the U.S. patent
application Ser. No. 11/054,265, filed on Feb. 9, 2005, which is
herein incorporated by reference in its entirety. The handle 12 may
instead, or also, include a connector or connectors suitable for
receiving stored energy from an external source, such as a hose
connected to a hospital utility source of pressurized gas or of
vacuum, or an electrical cord connectable to a power source.
Referring to FIGS. 3-4, one or more articulation bands 16 extend
proximally from the end effector 4 through the articulation region
14 and the shaft 10 to the handle 12. The articulation bands 16 may
be generally rectangular in cross section, where the bands 16 may
be significantly greater in the height dimension than in the
lateral dimension. In this way, the articulation bands 16 have a
suitably low moment of inertia to allow lateral flexing of the
articulation region 14. Alternately, the articulation bands 16 may
have any other suitable cross-section, and such cross-section need
not be constant along the length of either articulation band 16.
Further, the articulation bands 16 may be composed of a material
such as spring steel that allows the articulation bands 16 to
provide resistance to compressive force. Each articulation band 16
may be fixed at or near its distal end to the end effector 4 by
welding, adhesive, or any other suitable connection. Each
articulation band 16 may extend to a different lateral side of the
end effector 4. Alternately, at least one articulation band 16 may
be oriented relative to the end effector 4.
A central core 18 may be located proximal to the end effector 4.
The central core 18 may be fixed to the end effector 4, such as at
or near the proximal end of the end effector 4. As another example,
the central core 18 may be compressed between the end effector 4
and the shaft 6 or a fitting in the shaft 6 proximal to the
articulation region 14. The central core 18 may extend into and/or
completely through the articulation region 14. Consequently, at
least the portion of the central core 18 that is located in the
articulation region 14 is flexible and/or bendable. As one example,
at least the portion of the central core 18 located in the
articulation region 14 may be composed of a flexible material, such
as but not limited to silicone or elastomer. This flexible material
may be resilient, meaning that it tends to return to a neutral
state after deflection, or nonresilient, meaning that it tends to
remain in a deflected state after deflection. As another example,
at least the portion of the central core 18 located in the
articulation region 14 may include a plurality of segments. As
another example, the central core 18 may be the articulation insert
described in U.S. patent application Ser. No. 12/436,087, filed on
May 5, 2009 or U.S. patent application Ser. No. 12/477,065, filed
on Jun. 2, 2009 (collectively referred to as the "Insert
Documents"), both of which are herein incorporated by reference in
their entirety. The central core 18 may include passages 20 defined
generally longitudinally therein along which the articulation bands
16 are slidable. In this way, the passages 20 guide the
articulation bands 16, particularly as articulation begins.
Referring to FIGS. 2 and 4, at least one articulation button 22 may
be connected to the handle 12. Each articulation button 22 may be
held within a knob 24. Optionally, the knob 24 may be fixed to the
shaft 10, and the shaft 10 may be rotatable relative to the handle
12 such that rotation of the knob 24 causes the shaft 10, or at
least the portion of the shaft 10 rigid and proximal to the
articulation region 12, to rotate about its longitudinal axis
relative to the handle 12. However, the knob 24 may be fixed
relative to the handle 12 such that it does not rotate or move
relative to the handle 12. As another example, the knob 24 may be
omitted altogether.
Referring also to FIGS. 5-6, each articulation button 22 may
include a depression surface 26 that a user may press, as described
in greater detail below. The depression surface 26 may be the most
proximal surface of the articulation button 22, or may be any other
suitable surface of the articulation button 22. A compression
spring 28 may extend from the distal end of the articulation button
22, or from any other suitable portion of the articulation button
22. At least one pushing arm 30 may extend from the articulation
button 22. Each pushing arm 30 may extend generally longitudinally,
and flare inward near its distal end. As another example, at least
one pushing arm 30 may be oriented or configured differently. At
least one holding arm 32 may extend from the articulation button
22. As one example, each holding arm 32 may extending generally
transversely, and flare vertically near its distal end. As another
example, at least one holding arm 32 may be oriented or configured
differently. Two articulation buttons 22 may be utilized: a left
articulation button 22a and a right articulation button 22b, where
"left" and "right" are defined relative to the longitudinal
centerline of the shaft 10 viewed from the proximal end toward the
distal end. Alternately, only a single articulation button 22 may
be utilized. Where two pushing arms 30 and two holding arms 32
extend from each articulation button 22, optionally only one of
each arm 30, 32 may be used by each articulation button 20 to
actually control articulation. By providing two arms 30, 32 on each
articulation button 20, the same articulation button 20 can be
flipped such that the same configuration of articulation button
20
Referring to FIGS. 4 and 7-8, an articulation gear 40 is shown. The
gear 40 may be generally circular in shape. The articulation gear
40 may include outer teeth 42 defined along at least a portion of
its outer perimeter 44. The gear 40 may include an upper surface 46
and a lower surface 48. At least one upper tooth 50 may extend
upward from the upper surface 46. The upper teeth 50 may be
organized into two separate arcs on the upper surface 46. The outer
arc may include the outer, upper teeth 50a, and the inner arc may
include the inner, upper teeth 50b. As another example, the upper
teeth 50b may be omitted, and the upper teeth 50a may be organized
into a single arc on the upper surface 46. The outer, upper teeth
50a may be organized into an arc, where a neutral tooth 50c
occupies the center of the arc. The neutral tooth 50c may have two
substantially vertical lateral walls 52. The upper surface 53 of
the neutral tooth 50c may be substantially horizontal. On each side
of the neutral tooth 50c, each outer, upper tooth 50a may include a
ramp surface 54 sloping upward and away from the neutral tooth 50c.
Each upper tooth 50a may include a vertical wall 56 opposite the
ramp surface 54. The upper surface 58 of each upper tooth 50a may
be substantially horizontal. As another example, each upper tooth
50a may be shaped in a different manner. The vertical wall 56 of
each upper tooth 50a, and an arbitrary line parallel to the upper
surface 46 of the gear 40 lying on the ramp surface 54 of each
upper tooth 50a, may be substantially aligned with a radius of the
gear 40. Alternately, at least one upper tooth 50a may be oriented
differently on the upper surface 46 of the gear. The inner, upper
teeth 50b may be organized into an arc as well, where the neutral
tooth 50c is positioned further from the center of the gear 40 than
the inner, upper teeth 50b. On each side of the neutral tooth 50c,
each inner, upper tooth 50b may include a ramp surface 60 sloping
upward and away from the neutral tooth 50c. Each inner, upper tooth
50b may include a vertical wall 62 opposite the ramp surface 60.
The upper surface 64 of each upper tooth 50a may be substantially
horizontal. As another example, each inner, upper tooth 50b may be
shaped in a different manner. The vertical wall 56 of each upper
tooth 50a, and an arbitrary line parallel to the upper surface 46
of the gear 40 lying on the ramp surface 54 of each upper tooth
50a, may be substantially angled relative to a radius of the gear
40, and thus out of alignment with a radius of the gear 40.
Alternately, at least one upper tooth 50a may be oriented
differently on the upper surface 46 of the gear 40.
A spindle 70 may extend substantially perpendicular to the gear 40.
The longitudinal centerline of the spindle 70 may extend through
the geometric center of the gear 40. Alternately, the longitudinal
centerline of the spindle 70 may be offset from the center of the
gear 40. The spindle 70 may include an upper spindle 72 that
extends upward from the upper surface 46 of the gear 40 and a lower
spindle 74 that extends downward from the lower surface 48 of the
gear 40. Referring also to FIG. 9, the spindle 70 is received in at
least one receiver 76 defined in the knob 24. Advantageously, the
upper spindle 72 and lower spindle 74 are each received in a
separate receiver 76 in the knob 24. The gear 40 may be passive,
and may be biased to a neutral position by a torsion spring 78. An
anchor 80 may extend downward from the lower surface 48 of the gear
40, spaced radially apart from the lower spindle 74. The torsion
spring 78 wraps around the spindle 70 and the anchor 80, which are
spaced apart from one another, such that the torsion spring 78
biases the gear 40 to a neutral position.
Spindle teeth 82 may extend radially outward from the spindle 70.
As one example, the spindle teeth 82 extend radially outward from
the upper spindle 72. As another example, the spindle teeth 82 may
extend radially outward from any other portion of the spindle 70.
The spindle teeth 82 may be generally rectangular, or may have any
other suitable shape. For example, the spindle teeth 82 may be
spiral or cylindrical. The spindle teeth 82 may be oriented such
that their longer dimension is substantially vertical and their
shorter dimension is horizontal. However, the spindle teeth 82 may
be oriented in any other suitable direction or directions.
Referring also to FIG. 10, apertures 84 may be defined through the
articulation bands 16, near the proximal ends thereof. The
apertures 84 may be sized and shaped to receive the spindle teeth
82 therein. As described in greater detail, rotation of the gear 40
about the spindle 70 causes the spindle teeth 82 to rotate and
thereby cause differential motion of the articulation bands 16,
urging one articulation band 16 proximally and the other
articulation band 16 distally.
As another example of an articulation gear 40, referring to FIGS.
15-16, the articulation gear 40 may omit the upper teeth 50
described above with regard to the previous example. Instead, the
articulation gear 40 may include at least one cam path 100 defined
therein. At least one cam path 100 may be a depression or similar
recess defined in the articulation gear 40, with a lower surface
102. As another example, at least one cam path 100 may be defined
completely through the articulation gear 40, such that it does not
have a lower surface 102. Each cam path 100 may be a shape with a
closed perimeter, and each cam path 100 may have a separate, closed
perimeter. As another example, two or more cam paths 100 may be
interconnected, such as for ease of manufacturing. Each cam path
100 may be generally curved at least partially about the spindle
70. Each cam path 100 may include an inner surface 104 closer to
the spindle 70 and an outer surface 106 further from the spindle 70
than the inner surface 104. The outer teeth 42 of this example of
the articulation gear 40 may be configured substantially as set
forth above with regard to the previous example of the articulation
gear 40.
Referring also to FIGS. 15-17, one or more holder posts 110 may
extend into each cam path 100. The holder posts 110 may be opposed
ends, or other elements, of, a holder frame 112. In an initial,
neutral position in which the end effector 4 is not articulated,
each holder post 110 may reside in a first outer notch 114 in the
outer surface 106 of the corresponding cam path 100. The holder
posts 110 may be biased outward against the corresponding outer
surfaces 106 of the cam paths 100, in any suitable manner. As one
example, the holder frame 112 may be compressed inward in order to
place the holder posts 110 in the cam paths 100 during manufacture,
such that the holder frame 112 is sprung outward to bias the holder
posts 110 outward toward the outer surfaces 106 of the cam paths
100. By biasing the holder posts 110 into corresponding first outer
notches 114 in the outer surfaces 106 of the cam paths 100, the
articulation gear 40 is held securely in place with little or no
play.
Referring also to FIG. 18, the articulation buttons 22 utilized
with the articulation gear 40 described immediately above with the
cam path or paths 100 may be similar to the articulation buttons 22
described in the previous example, with a holder post deflection
cam 120 defined on an inner surface 122 of each articulation button
22. The holder post deflection cam 120 may be located in proximity
to and above the corresponding pushing arm 32 extending from the
articulation button 22. Alternately, the holder post deflection cam
120 may be located in a different position on the articulation
button 22. Where the articulation button 22 is utilized with the
exemplary articulation gear 40 that utilizes at least one cam path
100 instead of upper teeth 50, the holding arms 32 may be omitted
from the articulation button 22.
Referring also to FIG. 14, a portion of at least one feeder belt 90
may extend from the shaft 10 into, or be positioned within, the end
effector 4. The feeder belt 90 and its associated hardware may be
as set forth in U.S. patent application Ser. No. 11/851,379, filed
Sep. 6, 2007; U.S. patent application Ser. No. 11/956,988, filed
Dec. 14, 2007; and U.S. patent application Ser. No. 12/263,171,
filed Oct. 31, 2008 (the "Endocutter Documents"), which are herein
incorporated by reference in their entirety. In the interest of
brevity, the feeder belt 90 will not be described in detail herein.
Each feeder belt 90 may be a long, narrow, thin strip of material
from which one or more staples 92 extend. At least one staple 90
may be integral with the feeder belt 90, and frangibly connected to
the feeder belt 90 at one end, with the other end of the staple
being free. One row 94 of staples 92 may be located along each side
of the feeder belt 90. Each feeder belt 90 may be movable relative
to the end effector 4, as set forth in the Endocutter Applications,
such that the end effector 4 can be actuated multiple times without
the need to exchange cartridges or remove the end effector 4 from
the patient between actuations. The end effector 4 may be
configured generally as set forth in the Endocutter Documents, as
one example, or may be configured differently.
Operation
The user possesses the surgical tool 2. The end effector 4 is
placed in the body in proximity to its desired location relative to
tissue. Advantageously, the end effector 4 is advanced through a
trocar port or other minimally-invasive opening into the body.
Where the end effector 4 includes a staple holder 8 and anvil 6,
the end effector 4 may be opened such that at least the distal end
of the anvil 6 is spaced apart from the staple holder 8 to allow
tissue to be placed therebetween. However, the end effector 4 may
be any other implement for treating tissue.
Referring also to FIG. 4, in order to articulate the end effector 4
relative to the shaft 10, the user actuates one of the articulation
buttons 22. For clarity, the articulation of the end effector 4
leftward is described here. Articulation "leftward" refers to
motion of the end effector 4 generally to the left as viewed by the
user from the proximal toward the distal direction. In order to
articulate the end effector 4 leftward, the user actuates the right
articulation button 22b. The "right" articulation button 22b is the
one on the right as viewed by the user from the proximal toward the
distal direction. Actuation of the right articulation button 22b
may be performed by pressing the right articulation button 22b
generally distally. This exertion of force on the right
articulation button 22b overcomes the bias exerted by the
compression spring 28 against the right articulation button 22b in
the proximal direction.
Referring also to FIGS. 4-5, 7-8 and 10, as the right articulation
button 22b advances distally relative to the knob 24 or other
structure on the handle 12, the pushing arms 30 and holding arms 32
fixed to the right articulation button 22b advance distally as
well. Referring also to FIG. 11, as the lower pushing arm 30
advances, it encounters and engages an outer tooth 42 of the
articulation gear 40. Because the outer tooth 42 is laterally
spaced from the spindle 70, the force exerted by the lower pushing
arm 30 on the outer tooth 42 in the distal direction creates a
moment about the spindle 70, causing the articulation gear 40 to
rotate. As viewed from the underside of the articulation gear 40 in
FIG. 11, the articulation gear 40 rotates in a clockwise direction.
Consequently, as viewed from above, the articulation gear 40
rotates in a counterclockwise direction. As the right articulation
button 22b continues its motion distally and the articulation gear
40 rotates, the outer, upper teeth 50a of the articulation gear 40
rotate with the articulation gear 40. Referring also to FIG. 12,
during this rotation, the lower holding arm 32 of the left
articulation button 22a slides up the ramp surface 54 of the outer,
upper tooth 50a that is immediately to the left of the neutral
tooth 50c, as viewed from the top. The lower holding arm 32 may
flex as its distal end slides up the ramp surface 54, such that it
snaps downward toward and/or against the upper surface 46 of the
articulation gear 40 after it slides past the ramp surface 54 and
the upper surface 58 of the outer, upper tooth 50a.
At such time, the right articulation button 22b has been depressed
distally a sufficient amount, and may be released. The right
articulation button 22b is urged proximally to its original
position by the compression spring 28. As the right articulation
button 22b moves proximally, the lower pushing arm 30 retracts out
of engagement with the outer tooth 42 it had previously urged
distally. However, the lower holding arm 32 of the left
articulation button 22a holds the articulation gear 40 in place.
The torsion spring 78 biases the articulation gear 40 in a
direction opposite to the direction in which the articulation gear
40 had been rotated, such that the vertical wall 56 of the outer,
upper tooth 50a adjacent to the tip of the lower holding arm 32 is
biased against the lower holding arm 32. In this way, the lower
holding arm 32 of the left articulation button 22a holds the
articulation gear 40 in position.
During rotation of the articulation gear 40 as described above, the
upper spindle 72 rotates with the articulation gear 40, as do the
spindle teeth 82. The spindle teeth 82 engage apertures 84 of each
articulation band 40. Rotation of the articulation gear 40 and
upper spindle 72 in the direction described above--counterclockwise
as viewed from the top--thus causes the right articulation band 16
to advance distally, and the left articulation band 16 to retract
proximally. The left articulation band 16 may be fixed to the left
side of the end effector 4, and the right articulation band 16 may
be fixed to the right side of the end effector 4. As a result, that
distal force exerted on the right side of the end effector 4 by the
right articulation band 16, and the proximal force exerted on the
left side of the end effector 4 by the left articulation band 16,
cause a moment that bends the articulation region 12 laterally
leftward. Bending of the articulation region 10 relative to the
shaft 6 to change the orientation of the end effector 4 is referred
to as "articulating" the end effector 4. In response to a complete
depression and release of the right articulation button 22b, the
end effector 4 has thus articulated leftward in a discrete
increment. That is, the angular spacing between the outer, upper
teeth 50a along the circumference of the articulation gear 40
defines increments in which the articulation gear 40 rotates, and
in turn those increments of rotation are converted to increments of
articulation of the end effector 4. Put another way, each actuation
of an articulation button 22 causes the end effector 4 to
articulate a discrete and known amount.
If further articulation of the end effector 4 is desired, the user
may actuate the right articulation button 22b again. If so, the
articulation gear 40 rotates as described above, and the end
effector 4 articulates by another discrete amount, which may be the
same as or different then the previous discrete amount. The end
effector 4 may step through several discrete steps of articulation
as a result of several depressions of the right articulation button
22b. Referring also to FIG. 13, the end effector 4 may continue to
be articulated further leftward until the lower holding arm 32 of
the left articulation button 22a is holding the last outer, upper
tooth 50a. As one example, an additional actuation of the right
articulation button 22a simply results in no further articulation
of the end effector 4, because there is not another outer, upper
tooth 50a for the lower holding arm 32 to engage. As another
example, depression of the left articulation button 22a at this
point (or at an earlier point in the articulation of the end
effector 4) moves the lower holding arm 32 out of engagement with
the outer, upper tooth 50a that it had previously engaged, and
places the distal end of the lower holding arm 32 at a location
inward toward the spindle 70 such that the distal end of the lower
holding arm 32 is located radially inward from each of the outer,
upper teeth 50a. As a result, the torsion spring 78 urges the
articulation gear 40 back to its neutral position, and consequently
the end effector 4 returns to its original, non-articulated
position in which it is substantially longitudinally aligned with
the shaft 10.
As another example, where the articulation gear 40 includes a set
of inner, upper teeth 50b, the articulation gear 40 steps in
reverse toward the neutral position upon depression of the left
articulation button 22a. Referring also to FIGS. 4, 7 and 10, as
the left articulation button 22a is depressed, the distal end of
the lower holding arm 32 moves inward toward the spindle 70, out of
engagement with the outer, upper tooth 50a it had previously
engaged and held. As a result, the torsion spring 78 urges the
articulation gear 40 back toward its neutral position. However, the
distal end of the lower holding arm 32 encounters an inner, upper
tooth 50b as the articulation gear 40 moves toward that neutral
position. The angular force exerted by the torsion spring 78 may
then hold the inner, upper tooth 50b against the lower holding arm
32, such that the articulation gear 40 rotates a discrete increment
less than the discrete increments that it rotated during the
previous articulation of the end effector 4 leftward. Consequently,
the end effector 4 articulates rightward by a discrete angle that
is less than the discrete angles through which it had articulated
leftward. Alternately, the inner, upper tooth 50b simply arrests
the motion of the articulation gear 40, and the lower holding arm
32 then slides proximally into engagement with the next outer,
upper tooth 50a. In this way, the articulation gear 40 rotates a
discrete increment the same as the discrete increments in which it
had rotated previously, and the end effector 4 articulates
rightward by a discrete angle substantially the same as the
discrete angles through which it had rotated during the previous
articulation of the end effector 4 leftward.
For conciseness and clarity, articulation of the end effector 4 in
the left direction using the right articulation button 22b has been
described above. Articulation of the end effector 4 in the right
direction, using the left articulation button 22a, is performed
substantially as set forth above, in a reversed, mirror-image
manner. Optionally, the shaft 10 may be rotatable relative to the
handle 12, as set forth in commonly-assigned U.S. Pat. No.
7,918,376, which is herein incorporated by reference in its
entirety. In this manner, the end effector 4 can be rotated as well
as articulated left and right, in order to place the end effector 4
in a desired position within a patient.
As another example, a single articulation button 22 may be
provided, rather than the two articulation buttons 22a, 22b
described above. If so, the neutral position of the articulation
gear 40 is a rotation all the way to one side, such that the end
effector 4 is fully articulated laterally in the neutral position.
The end effector 4 then may be articulated in discrete increments
from that neutral position, utilizing only a single articulation
button 22.
Turning to the exemplary articulation gear 40 that includes at
least one cam path 100 defined therein, instead of upper teeth 50
defined thereon, articulation may be performed in a similar but
different manner. Referring to FIGS. 15-18, in order to articulate
the end effector 4 relative to the shaft 10, the user actuates one
of the articulation buttons 22. For clarity, the articulation of
the end effector 4 rightward is described here. Articulation
"rightward" refers to motion of the end effector 4 generally to the
right as viewed by the user from the proximal toward the distal
direction. In order to articulate the end effector 4 leftward, the
user actuates the left articulation button 22a. The "left"
articulation button 22a is the one on the left as viewed by the
user from the proximal toward the distal direction. Actuation of
the left articulation button 22a may be performed by pressing the
left articulation button 22a generally distally. This exertion of
force on the left articulation button 22a overcomes the bias
exerted by the compression spring 28 against the left articulation
button 22a in the proximal direction.
Referring also to FIG. 19, as the left articulation button 22a
advances distally relative to the knob 24 or other structure on the
handle 12, the pushing arm 30 fixed to the left articulation button
22a advances distally as well. As the pushing arm 30 advances, it
encounters and engages an outer tooth 42 of the articulation gear
40. Because the outer tooth 42 is laterally spaced from the spindle
70, the force exerted by the pushing arm 30 on the outer tooth 42
in the distal direction creates a moment about the spindle 70,
causing the articulation gear 40 to rotate. As viewed from the
upper side of the articulation gear 40 in FIG. 19, the articulation
gear 40 rotates in a clockwise direction. As the articulation gear
40 rotates, some of the energy of motion of the left articulation
button 22a is stored in the torsion spring 78, which is thereby
biased toward the neutral position of the articulation gear 40 as a
result of that energy storage.
As the articulation gear 40 rotates, each holder post 110 moves in
the corresponding cam path 100 defined in the articulation gear 40.
The holder post 110 closest to the left articulation button 22a may
be referred to as the left holder post 110a, and the corresponding
cam path 100 may be referred to as the left cam path 100a. The
holder post 110 closest to the right articulation button 22b may be
referred to as the right holder post 110b, and the corresponding
cam path 100 may be referred to as the right cam path 100b. As the
left articulation button 22a moves distally, the distal end of the
holder post deflection cam 120 encounters the left holder post
110a, urging that left holder post 110a inward, as seen in FIG. 20.
In this way, the holder post deflection cam 120 urges the left
holder post 110a out of engagement with the corresponding first
outer notch 114 in which that left holder post 110 had initially
resided. As seen in FIG. 19, as the articulation gear 40 rotates
clockwise, the left holder post 110a--now out of engagement with
the first outer notch 114--can move substantially freely into the
portion of the cam path 100 located above the left holder post 110a
on the page. That is, the left holder post 110a is biased toward
the outer surface 106 of the left cam path 100a, and that outer
surface 106 of the left cam path 100a is smooth on the portion of
the left cam path 100a that the left holder post 110a encounters
during clockwise rotation of the articulation gear 40 from a
neutral position (which is during rightward articulation of the end
effector 4).
Additionally, as the articulation gear 40 rotates clockwise, the
right holder post 110b remains biased outward toward the outer
surface 106 of the right cam path 100b. Because the right
articulation button 22b has not moved and does not move distally
during rightward articulation, the holder post deflection cam 120
on the right articulation button 22b does not move, such that it
does not urge the right holder post 110b out of engagement with its
corresponding first outer notch 114. However, as the articulation
gear 40 rotates clockwise, the right holder post 110b slides
against the first ramp 116 defined in the outer surface 106 of the
cam path 100b that is located distal to the first outer notch 114.
That is, engagement between the right holder post 11b and the first
outer notch 114 prevents counterclockwise rotation of the
articulation gear 40, but allows clockwise rotation of the
articulation gear 40 by allowing the right holder post 110b to
slide along the first ramp 116. The first ramp 116 may be angled
toward the spindle 70, such that as the right holder post 110b
slides along the first ramp 116, the first ramp 116 also urges the
right holder post 110b inward toward the longitudinal centerline of
the knob 24. As the articulation gear 40 continues to rotate
counterclockwise, under the influence of engagement between the
pushing arm 30 of the left articulation button 22a and an outer
tooth 42 of the articulation gear 40, the right holder post 110b
slides off the proximal end of the first ramp 116 and snaps into
the second outer notch 118. The second outer notch 118 is located
in the outer surface 106 of the cam path 100b, counterclockwise
from the first outer notch 114. The length of the first ramp 116 is
related to the amount of clockwise motion of the articulation gear
40, which in turn is related to the length of distal travel of the
left articulation button 22a. The length of the first ramp 116
corresponds to the full stroke of the left articulation button 22a
such that a full stroke (i.e., complete depression) of the left
articulation button 22a causes the right holder post 11b to move
from the first outer notch 114 to the second outer notch 118.
At this point, the left articulation button 22a is released, moving
the left holder post 110a back into engagement with a smooth
section of the outer surface 106 of the cam path 100a. The right
holder post 110b is engaged with the second outer notch 118. This
engagement, coupled with the bias of the torsion spring 78 in the
counterclockwise direction, holds the articulation gear 40 in
position, such that the end effector 4 has been articulated through
a discrete angle and is now held at that angle. As set forth above,
engagement between the spindle teeth 82 and the articulation bands
16 causes that articulation of the end effector 4.
Articulation of the end effector 4 through successive additional
rightward angular iterations, if desired, may be accomplished by
repeating what is set forth above. Referring to FIGS. 21-23,
successive depressions of the left articulation button 22a cause
the left holder post 110a to slide along a smooth portion of the
outer surface 106 of the cam path 100a, and cause the right holder
post 110b to slide successively along ramps 126, 128, 130 to outer
notches 121, 122, 124. Of course, more or fewer ramps and/or
notches may be provided in order to provide for more or less
articulation, and/or to provide for larger or smaller discrete
angles of articulation of the end effector 4.
When the articulation gear 40 has reached the point of rotation at
which the cam path 100b cannot rotate clockwise any further due to
engagement of the right holder post 110b with a final notch 124
and/or with an end of the cam path 100b, the articulation gear 40
cannot rotate further, and articulation rightward is complete. It
will be apparent from the description above that articulation of
the end effector 4 leftward happens as set forth above, but in a
mirror-image manner.
The user may wish to return the end effector 4 in the opposite,
leftward direction at that time. Of course, the user may wish to
articulate the end effector 4 leftward before the end effector 4
reaches a point of rightmost articulation. In order to articulate
the end effector 4 leftward after at least one discrete
articulation rightward, the user depresses the right articulation
button 22b. Referring also to FIG. 24, as the right articulation
button 22b advances distally relative to the knob 24 or other
structure on the handle 12, the pushing arm 30 fixed to the right
articulation button 22b advances distally as well. As the pushing
arm 30 advances, it encounters and engages an outer tooth 42 of the
articulation gear 40. Because the outer tooth 42 is laterally
spaced from the spindle 70, the force exerted by the pushing arm 30
on the outer tooth 42 in the distal direction creates a moment
about the spindle 70, causing the articulation gear 40 to rotate.
As viewed from the upper side of the articulation gear 40 in FIG.
19, the articulation gear 40 rotates in a counterclockwise
direction. As the articulation gear 40 rotates, some of the energy
of motion of the left articulation button 22a is released from the
torsion spring 78, which is biased toward the neutral position of
the articulation gear 40 as a result of stored energy within the
spring 78.
As the articulation gear 40 rotates, each holder post 110 moves in
the corresponding cam path 100 defined in the articulation gear 40.
Referring also to FIG. 23, the left holder post 110a was not
previously engaged with an outer notch, and slides along a smooth
portion of the outer surface of the cam path 100a as the
articulation gear 40 rotates counterclockwise. As the right
articulation button 22b moves distally, the distal end of the
holder post deflection cam 120 encounters the right holder post
110b, urging that right holder post 110b inward, as seen in FIG.
24. In this way, the holder post deflection cam 120 urges the right
holder post 110b out of engagement with the corresponding outer
notch 124 in which that right holder post 110b had previously
resided. (The articulation described herein, returning from a
previous articulation in the other direction, is performed the same
way regardless of which outer notch has engaged the right holder
post 110b; the discussion with regard to the final outer notch 124
is for clarity.) As the articulation gear 40 rotates
counterclockwise, the right holder post 110b is held inward from
the distal end of the ramp 130 located proximal to the outer notch
124. As a result, that right holder post 110b slides between the
ramp 130 and the inner surface 104 of the cam path 100b. In this
way, the holder post deflection cam 120 engages the right holder
post 110b to allow counterclockwise motion of the articulation gear
40. As the articulation gear 40 continues to rotate
counterclockwise under the influence of engagement between the
pushing arm 30 of the right articulation button 22a and an outer
tooth 42 of the articulation gear 40, the right holder post 110b
moves into engagement with the outer notch 122 located clockwise
from the previous outer notch 124. That engagement prevents further
counterclockwise motion of the articulation gear 40, such that the
articulation back toward the neutral position is stopped, and
holding the articulation gear 40 in position. The position occupied
by the end effector 4 may be the previous discrete angular position
occupied by the end effector 4 prior to the return articulation
described immediately above. The end effector 4 has been
articulated through a discrete angle and is now held at that angle.
The right articulation button 22b is released; however, the right
holder post 110b is already engaged in a notch in the outer surface
106 of the cam path 100b, such that removal of any bias inward of
the right holder post 110b does not cause it to move relative to
the cam path 100b.
Articulation of the end effector 4 through successive additional
leftward angular iterations, if desired, may be accomplished by
repeating what is set forth immediately above, until the end
effector 4 returns to the neutral position and the articulation
gear 40 returns to the neutral position shown in FIG. 16. After the
articulation gear 40 has returned to the neutral position, end
effector 4 return is complete. If the user wishes to articulate the
end effector 4 further leftward, that articulation of the end
effector 4 leftward may be performed as set forth above with regard
to rightward articulation, but in a mirror-image manner.
Once the end effector 4 is in the desired position, the end
effector 4 may be manipulated in any manner. As one example, the
end effector 4 may be closed if it is open, such as by moving the
anvil 32 toward the staple holder 30 to clamp tissue. The end
effector 4 then may be actuated to treat tissue. As one example,
where the surgical tool 2 includes one or more feeder belts 90,
staples 92 may be deployed into tissue from the staple holder 6
against the anvil 4. The feeder belt or belts 90 then may be
advanced, placing a fresh set of staples 92 in position for
deployment within the staple holder 6. Such deployment and
advancement may be accomplished as set forth in the Endocutter
Documents. Afterwards, the end effector 4 may be reoriented in the
manner described above, articulating the end effector 4 in a
different direction, so the end effector 4 may treat tissue again.
Alternately, the end effector 4 is simply withdrawn from the
patient after the first tissue treatment.
The operation of the surgical tool 2 may be carried out in the
course of testing at a factory or other location. If so, the user
that possesses the surgical tool 2 may be a technician, machine or
text fixture that exercises the surgical tool 2 in the course of
testing. The term "tissue," in the context of testing the surgical
tool 2 only, includes any substance or material used as a
substitute for tissue in the course of testing.
While the invention has been described in detail, it will be
apparent to one skilled in the art that various changes and
modifications can be made and equivalents employed, without
departing from the present invention. It is to be understood that
the invention is not limited to the details of construction, the
arrangements of components, and/or the method set forth in the
above description or illustrated in the drawings. The use of terms
such as "upward" and "downward" in this document refers to the
orientation of parts on the page for descriptive clarity, and in no
way limits the orientation of the device in use. Statements in the
abstract of this document, and any summary statements in this
document, are merely exemplary; they are not, and cannot be
interpreted as, limiting the scope of the claims. Further, the
figures are merely exemplary and not limiting. Topical headings and
subheadings are for the convenience of the reader only. They should
not and cannot be construed to have any substantive significance,
meaning or interpretation, and should not and cannot be deemed to
indicate that all of the information relating to any particular
topic is to be found under or limited to any particular heading or
subheading. Therefore, the invention is not to be restricted or
limited except in accordance with the following claims and their
legal equivalents.
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